Dr. Concannon's immediate goals are to fill in major knowledge gaps in emergency triage and care of patients with ST segment elevation myocardial infarction (STEMI), and to develop adaptive and efficient planning tools for regionalization of STEMI care. Dr. Concannon's long-term career goals are to develop and implement similar planning and policy tools for a range of high cost and high intensity patients. In this project, Dr. Concannon will identify optimal strategies for increasing population access to primary percutaneous coronary intervention (PCI). Policy recommendations will be sensitive to county-level characteristics, such that optimal strategies in one county may be different from those in another. Strategies are grouped in three categories: 1) emergency medical service (EMS)-based triage;2) hospital-based triage;3) hospital expansion. This award will make it possible to pursue training, acquire data, develop planning tools, and publish manuscripts corresponding to each of the specific aims: 1. Estimate the effectiveness of alternative strategies;2. Estimate the costs and cost effectiveness of alternative strategies;3. Evaluate relationships between county characteristics and the cost effectiveness of alternative strategies. Courses are planned in hierarchical modeling, applied geographic information systems (GIS), decision analysis, and the responsible conduct of research. Dr. Concannon is Assistant Professor of Medicine at Tufts-New England Medical Center (Tufts-NEMC) and Tufts University School of Medicine (TUSM). Tufts-NEMC is a 421-bed teaching hospital with 16,337 annual admissions, 35,650 emergency/trauma visits, and 27 insurer contracts. The Institute for Clinical Research and Health Policy Studies (ICRHPS), where Dr. Concannon sits, is comprised of Centers specializing in mathematical and analytic model development, cardiac health services research, decision analysis, biostatistics, and clinical and health policy studies. Tufts University maintains a Geographic Information Systems (GIS) Center for integration of GIS into the research of Tufts'faculty, staff, and students.